Monthly Archives: December 2009

Stretching leg muscles with a Thera-band® improves flexibility in the legs, but also relieves tension in the hips and low back with minimal time and effort. The Thera-band is a resistance exercise band available in a variety of strengths indicated by color (the thicker the band the stronger the resistance). Bands are often used in physical therapy rehabilitation, since patients can maintain a consistent practice working at home and strength development can be easily monitored with the progressive color coding system. They can be purchased individually or in bulk rolls and are sold under a variety of brand names offering latex and latex-free versions. (I prefer black Cando bands.) The 50-yard roll can be cut into individual bands making it economical to provide multiple clients and mat class attendees with equipment. Although there are multiple uses for Thera-bands in an exercises program, leg stretches yield quick results and are easy for most clients to practice.

As with any stretching program, consistency with a long-term commitment to practice is essential. Using a pain scale of 1-10 with “10” being the most intense is a good guide to check in and keep clients on track. As a general gauge, “7” on this scale means your client will be actively stretching without strain or pain, but individuals vary and some may require less intensity. Microscopic tearing of the muscle fibers is a risk for overstretching and the scar tissue that develops can lead to a decrease in muscle elasticity so “more” is not always better. If your client has strained a muscle, stretching may cause further harm, so be sure no chronic condition exists prior to starting a new routine.

Stretching after warming the muscles is preferable so a brief warmup such as a short walk can be useful to elasticize the collagen fibers prior to stretching. Stretches should be held for thirty seconds to a minute and should evolve; as the stretch is held, the intensity diminishes requiring the limb to move into a greater range to maintain the “7” on the pain scale. These stretches will always be a bit uncomfortable (they should not be painful). Regular practice will increase range of motion and the discomfort will be experienced similarly in the newer more flexible range.

The stretch reflex is the body’s protective tool to prevent muscle fibers from overstretching and helps protect the tendon origins and insertions from being over-pulled. When the stretch intensifies, the muscle being stretched contracts to prevent it from being forced beyond normal range. Putting the muscle being stretched in contraction helps to inhibit this reflex and can make the process safer and more comfortable. For example, when stretching the hamstrings with the Thera-band, press the leg slightly toward the floor to engage the hamstrings while pulling the band with the hands bringing the leg closer to the chest.

Conscientious breathing will allow the body to relax with the stretch. Breathe into the tension of the stretch on the inhalation and let it go on the exhalation. This push/pull quality (pushing the limb and pulling with the band) applies to all of the following stretches and will make them feel more like pushing through peanut butter or working with taffy rather than the slack feeling of hanging in a hammock.

Although the following descriptions indicate which hand to use to hold the band, this is a personal choice based on comfort and body limitations. For example, if your client has arthritis a two-handed hold might be more comfortable or Thera-band exercise handles could be used to reduce grip tension.

BAND STRETCHES

Calf

The objective is to stretch the gastrocnemius and the soleus muscles. Place the band with its full width across the metatarsals (don’t let it bunch up like a tourniquet) and hold each side of the band in either hand. Make sure you do not have a “death grip” on the band or your fingers will fatigue too quickly. Inhale—plantar flex the ankle moving the metatarsals (or ball of foot) into a demi pointe (half point) while spreading the toes. Exhale—dorsiflex the ankle and keep the toes spread. Repeat this approximately five times making sure to keep the hip of the stretching leg pressing into the floor, so the initiation of the movement starts at the core with the ankle being the end result. Variations of this stretch include ankle inversion, eversion and circles. Be careful on inversion to press from the fifth (pinky) metatarsal straight from the body without “sickleing” (shifting medially). A sickled foot is an instable ankle twist waiting to happen in the future, because it lacks strength. The objective of this exercise is to develop ankle strength and flexibility in the calf. This kind of ankle work is very useful for ballet dancers trying to achieve more articulation in their feet.

Hamstrings

The objective is to stretch the semimembranosus, semitendinosus and biceps femoris muscles. After working the ankle in the above exercise remain in the dorsiflexed position. Inhale—press the thigh toward the floor slightly to activate the hamstrings while keeping the band pulled toward the chest. Exhale—pull the leg closer to the chest while retaining some tension in the hamstrings as if still trying to lower the leg to the floor. Never “yank” on the leg. This stretch can be performed with a bent or straight knee. Both are useful and stretch either the belly of the muscle or the back of the knee. If the knee is bent, keep energy reaching through the heel toward the ceiling so the stretch remains active. This stretch is like a tug of war with the heel being one team and the ischial tuberosity (sitbone) being the other. Both sides need to actively pull on the rope.

Inner Thigh/Adductors

The objective is to stretch the adductor magnus, adductor longus, adductor brevis, gracilis and the pectineus muscles. It is sometimes more comfortable to hold the band in the same hand as the working leg—left hand holds the band when opening the left leg so the right shoulder can stay open and relaxed on the floor. Open the leg laterally while externally rotating the hip joint. The opposite side of the pelvis should remain on the floor and the body should not roll toward the open leg. If your client is unable to keep the opposite hip down, bend and externally rotate the knee of the leg on the floor to provide a little more leverage in the counterbalance. Be sure the chest presses into the floor and the abdominal muscles are actively engaged. If the abs are not engaged and the ribs lift off the floor, your client may push the head into the floor for leverage creating a discomfort in the neck and shoulders. Use the same push/pull tension strategy as explained in the previous stretches (inhale while creating tension and exhale as the stretch increases). As the leg moves wider and externally rotates, the foot moves closer to the ipsilateral ear, but the hip should remain anchored and the pelvis square. There is a tendency for people to hike the hip in an effort to achieve greater range of motion. A hiked hip does not stretch the inner thigh more—it is like the tug of war image used before except one team walks forward and the other walks backward as they pull apart. The hip must remain down to get the oppositional energy flow.

Outer Hip/Abductors

The objective of this stretch is to stretch the gluteus medius, gluteus minimus and tensor fasciae latae muscle down into the illiotibial tract. Move the leg medially across the center of the body until the hip slightly lifts off the floor, but not so much that a full twist occurs in the lumbar region. It is not important for the leg to reach across the body very far, the stretch occurs when the hip pulls back into the floor (the foot in the band remains held in space and the hip pulls downward in opposition). Having the band in the opposite hand of the leg that is stretching contributes to this opposition. Inhale—pull on the band slightly and press the leg laterally into the band to create tension. Exhale—keep the foot held in space and drop the hip toward the floor using the internal obliques to rotate the spine. Be sure to also lengthen the waist by pulling the head and tailbone apart.

Circles

The circumduction of the hip joint reviews all the previous stretches. The image of an ice cream cone can be a useful tool to mimic the conical pathway. The emphasis should be to press the hip into the floor where the ice cream would go at the tip, and then draw the lip of the cone either on the ceiling or on the walls if your client has greater range. Keep that feeling of pushing through taffy and guide your client to make sure that each hamstring/adductor/abductor position previously stretched is addressed. The leg must externally rotate each time the leg moves laterally to guide the ball in the socket of the hip joint comfortably. Correct the pathway or limit the range if your client experiences clicking in the hip joint. Be sure to circle both clockwise and counter-clockwise three to five times each.

Splits

The objective is to energize and lengthen both legs while simultaneously activating the core. The feeling should be like doing splits on the ceiling. Hold the band in both hands with an underhanded grip to encourage the shoulders to stay down. Split the legs apart with the lower leg off the floor and lift the head off the floor as well (if your client has neck discomfort keep the head on the floor). Inhale—press the thigh into the band as in the previous hamstring stretch. Exhale—pull the top leg slightly toward the chest while preventing the hip from hiking and deepen the belly scoop. Draw in the transversus abdominis deeper on each exhalation. Hold for three to five breath cycles.

The improved range of motion from regular stretching may help decrease injuries by preparing the body for a variety of activities. Mayo Clinic physical medicine and rehabilitation specialist Edward R. Laskowski, M.D. says,

“If your joints are not able to go through their full range of motion because of muscle tightness, sports and exercise activities may put an excessive load on the tissue and contribute to injury. Think of a runner with tight calf muscles and a tight Achilles tendon running up a hill. This activity requires that the ankle bend up to accommodate the slope of the hill. But if it can’t because of tightness, the runner may be at risk of getting Achilles tendon irritation and injury.”

There is a correlation between leg stretching and improved posture in the spine. Tight hamstrings will encourage a posterior pelvic tilt eliminating the necessary lumbar curve for lifted posture (see article The Use of Imagery to Help Your Client Find Lift Through the Core). The lumbar lift and core stability available in a neutral pelvic placement is diminished with the downward pressure of the tucked pelvis. If your client experiences low back pain, leg stretching with a band may be one component in a program to improve this condition.

Regular leg stretching with Thera-bands can improve mobilization at the hip and ankle joints better preparing your clients for whatever activities they choose. Bands are portable and require almost no storage space and are great for traveling. The leg stretch series also increases blood flow, which facilitates the body’s ability to heal and repair itself. Have your client notice the energy flow into the stretched leg prior to switching sides. Your client should be able to perceive the asymmetry of the stretched and unstretched leg. Noticing an immediate difference for the effort exerted is a great motivation to keep stretching and will keep your client consistently practicing at home. Better posture, improved range of motion, healthy blood flow…what’s not to love!